598 (2) iNO. sTR88T ((QQ ;.�.a�.: dc. ..
C TION�FOR G S PERMIT
t - ITY�OF CUPERTINO-
Ne
'.Date•I��I � � _? ��'��`I , .195_ � Permit No.
Fee $
CITY n� on is CDT ntn
Ap lication.is hecebyImade to the City of Cupertino for a permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
v
c
a Use of Premises�"��_
rn � ✓LU !t°d es �—
Address
CONTRAC t, AGENT•AGENT•'
P neAPProv
t. PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance I Units Fees II New Replace Relocate
Gas;Ranges
Wall Heaters
Gas;,Plates �
.Circulating Heaters
Blower Furnaces I ��
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
CNAME TYPE)
pp lance Fees I f
Inspected and Approved ...... -------:... ...._..._.............._..........._... - '
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main—�
,Gas Piping Fees ��///
_1
Tested and Approved �l1.7.Q-.....�..
' DATE INSPECTOR